Background. Transoral endoscopic thyroidectomy by a vestibular approach (TOETVA) is a novel technique for thyroid cancer operation. Compared to other endoscopic approaches including transaxillar or bilateral axillo-breast approach, it requires substantial dissection to reach the thyroid and provides the shortest access to the target organ. The aim of this study was to report on our initial experiences with transoral endoscopic thyroidectomy by a vestibular approach with endoscopic retractor for the management of thyroid carcinoma. Methods: From September 2016 to March 2017, 30 patients with thyroid cancer underwent TOETVA. We used a three-port technique through the oral vestibule with endoscopic retractor, and thyroidectomy with central compartment dissection was performed endoscopically using conventional laparoscopic instruments and an ultrasonic device. Results. All patients had papillary thyroid carcinoma. Less than total or total thyroidectomy with ipsilateral central compartment node dissection was performed (29 vs. 1). The mean operation time was 95.5 min (range, 62-213 min). The average number of lymph nodes resected was 4.3 (range, 1-11). Two patients experienced a transient hoarseness, which was resolved within 3 months. Most of the patients could return home within 3 days after surgery. Conclusion: TOETVA is safe and feasible and provides an excellent cosmetic outcome.